A New York state municipality that operates an ambulance service cannot waive deductibles, co-payments or coinsurance amounts for community residents, officials say.
The New York State Insurance Department Office of General Counsel (OGC) has published that conclusion in a response to a question about waivers of health insurance cost-sharing amounts.
Someone asked the New York department when a municipal ambulance service could, without an insurer’s knowledge, waive co-payments, co-insurance, or deductibles for community residents who are not in Medicare plans.
The Office of the Inspector General of the U.S. Department of Health and Human Services says municipalities can waive cost-sharing amounts for Medicare plan enrollees.
State law governs most health coverage arrangements in New York, and New York officials have held in a number of opinions that waiving charges without the knowledge of the insurer may constitute insurance fraud, officials write in the new opinion.
“These opinions recognize that if an insurer is not aware of the amount that a provider is actually charging, then the claim may contain materially false information concerning any material fact thereto,” officials say.